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The EvidenceNOW initiative, one of AHRQ’s solutions for  revitalizing the nation’s primary care system, uses a model of external support to help primary care practices implement the latest evidence into practice and improve their capacity for quality improvement. The EvidenceNOW model uses external practice coaches or facilitators and other external supports to help small and medium-sized practices optimize workflows, effectively use electronic health records, and manage other tasks essential to improving quality of care and patient outcomes. In recent decades, primary care practices have been hampered by fragmentation of the healthcare system, a lack of resources to meet patient needs, and limited access to an infrastructure to support quality improvement (QI). ´óÏóÊÓƵdeveloped EvidenceNOW to help them meet these challenges.

EvidenceNOW: Advancing Heart Health

EvidenceNOW: Advancing Heart Health, launched in 2015, was a $112 million effort and was AHRQ’s first test of the EvidenceNOW model. The project’s four goals were to:

1. Help practices implement evidence to improve healthcare with a focus on heart health.
2. Build primary care practice capacity to receive and incorporate evidence in the future.
3. Learn how external quality improvement support helps primary care practices improve the way they work and improve the health of their patients.
4. Build and disseminate a model of how to improve primary care with external supports.

To accomplish this work, ´óÏóÊÓƵawarded grants to seven regional cooperatives. The cooperatives provided support to primary care practices to help them integrate evidence-based approaches into patient care and to offer services, such as onsite practice facilitation and coaching and health information technology support, to help practices improve delivery of heart health care. Together they worked with more than 5,000 clinicians at more than 1,500 practices that serve about 8 million patients. ´óÏóÊÓƵawarded an eighth grant for an independent national evaluation of EvidenceNOW: Advancing Heart Health. More than 100 studies have been published based on the project’s findings.

EvidenceNOW: Managing Unhealthy Alcohol Use

AHRQ's initiative to reduce unhealthy alcohol use was launched in October 2019, when the Agency awarded 3-year grants to six institutions across the country. The purpose of the program was to disseminate and implement into primary care practices evidence-based approaches to improve the use of screening for unhealthy alcohol use, brief intervention for those at risk, and medication therapy for alcohol use disorder.

Together, the six grantees worked with nearly 300 primary care practices. Grantees received support from ´óÏóÊÓƵthrough a resource center and participation in a learning community. Findings from grantees’ evaluations of their dissemination and implementation efforts and from a cross-grantee evaluation were presented at a in 2024.

EvidenceNOW: Building State Capacity

This initiative invested $18 million over 3 years to four grantees to improve heart health and help reduce cardiovascular disease disparities by engaging with primary care practices and disseminating and implementing patient-centered outcomes research (PCOR) findings to improve care delivery. The initiative aimed to address health equity in primary care by working with healthcare organizations, public health, and primary care practices in States with the highest rates of preventable cardiovascular disease events.

Four state-based teams formed cooperatives by aligning clinical, public health, and community interventions and working with State partners who collectively had the resources, skills, and commitment to support primary care practice improvement. They built statewide networks of primary care practices and provided selected practices with the QI services they needed to improve heart health. Initial work focused on improving the management of blood pressure and decreasing tobacco use. 

Results from this project contributed to the development of a how-to guide, Developing and Sustaining State-Based Infrastructure To Support Primary Care Quality Improvement. At a final meeting, grantees identified key take-aways for developing state cooperatives to accelerate the implementation of evidence into practice.

EvidenceNOW: Managing Urinary Incontinence in Women

This initiative was launched in 2021 and will continue through 2026. The purpose of this initiative is to disseminate and implement the latest PCOR evidence on nonsurgical treatments for urinary incontinence in women in primary care practices. At its core it uses the EvidenceNOW model of primary care practice improvement support. The initiative also focuses on increasing integration between primary care and specialty care practices and aligning improvement strategies with community-based organizations and health systems.